Elisa on Cediranib

[Olga]

I agree that it appears that the response to a standard chemotherapy always happened only after local treatment/surgeries, but you should also realize that a response does not equal to the improved survival time overall. The MTD chemo regimens (maximum tolerated doze) are known to increase the neo-vascularization process as a side effect, so if the response is incomplete and there are some residual alive mets, they recover and grow faster than before. And besides, we have never seen any meaningful response in a primary tumors, only in the mets, the primary has to go surgically, it is the only known way to deal with it. I have seen some works that in some places unresectable primaries are getting treated by the cryo in attempt to shrink it. It can also be treated by the neutron radiotherapy as there were cases when ASPS primary responded to this type of radiation.

[Johannes]

Dear Olga and Bonni,

Thank you so much once again; this is, as usual, extremely helpful. I don't believe that Elisa's oncologists take time to make some more in-depth research on ASPS to be able to make this kind of reasoning, which is why the board and your opinions are so important. The suggestion to try chemo at this point was, I think, not based on any particular considerations but rather on the general idea that "sometimes it works". My impression is that they follow the conventional approach that resecting the primary doesn't make sense in case of a metastasized disease.

Thanks, Olga, for also pointing to cryo and neutron radiotherapy. Two different sarcoma surgeons in Montreal have confirmed that the primary would be resectable but have not recommended carrying out the surgery, mostly for fear that Elisa's quality of life might worsen due the heavy surgery (a very significant portion of the muscle would have to be removed, etc.). Perhaps it would be good to think about cryo and/or neutron radiotherapy to attempt to shrink the primary before a resection. Surprisingly one of the surgeons said that even if the primary shrunk thanks to a systemic treatment, the surgery would not really be any different, meaning he would have to cut just as much. I guess this is related to the highly vascularized nature of the tumour, but does this make sense to you?

Best wishes,
Johannes

[Olga]

May be it has to do with the general rules of this type of surgery - they remove all muscle compartment where the tumor is located and it may be now confined to this compartment - and it will be still there even if it shrinks, so the surgical outcome (the whole compartment removed) - still stays the same? Anyways, get the second opinion from the Washington sarcoma center - Dr. Martin Malawer here http://sarcoma.org/Sarcoma/ you can even simply fill the form provided asking if there are any techniques or chance they have to eliminate the need for the more radical surgery to preserve the QOL.

[MarietjievdMerwe]

Johannes,
I would just like to find out whether you have made a decission on Elisa's treatment yet? From our excperience with Tok I can only wish you the best of luck. He responded so good to the traditional chemo, we are still a bit stunned!

Of course we would recommend the treatment, but this is a huge decission to make. Dr Cohen explained from the beginning that he had to receive the chemo over a period of 96 hours till the minute for the chemo to "get to all the cells". Of course this made Tok miserable and at times very very sick, but in the end it was worth it.

Very best of luck.

Thinking of you and Elisa.

Kind regards.
Marietjie.

[D.ap]

The next journey that Elisa and family take
http://www.cureasps.org/forum/viewtopic.php?f=63&t=781